4 Tips Take Your MOCA Coding From ‘Meh’ to Marvelous

Fri, Apr 28, 2017

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MOCA therapy for varicose veins

Move over, unlisted vascular surgery code 37799! That’s what mechanochemical ablation (MOCA) codes 36473 and +36474 said when they became reportable CPT® codes on Jan. 1, 2017. Give your use of these new endovenous ablation codes a check-up with the four pointers below.

1. Read the Descriptors All the Way Through

Reading the descriptor is a pretty obvious first tip, but there’s a reason for that. Here are the descriptors:

  • 36473 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated)
  • +36474 (… subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)).

Just look at some of the fun facts you can learn:

  • The codes apply to percutaneous services in an extremity
  • Code 36473 is for the first vein, and +36474 is for one or more subsequent veins treated in that extremity
  • The codes include all imaging guidance and monitoring.

2. Use the Code Only for the Intended Tech

What it is: These codes apply to “concomitant use of an intraluminal device that mechanically disrupts/abrades the venous intima and infusion of a physician-specified medication in the target vein(s),” according to CPT® guidelines.

That’s a mouthful. A device brand name you’ll see tied to MOCA is ClariVein®IC. In the procedure, the provider administers local anesthesia and inserts an infusion catheter with a special wire tip into the incompetent (varicose) vein. Remember that any imaging guidance used is covered under the surgical code. She attaches the catheter to a motor drive unit. The wire tip rotates quickly inside the vein and delivers the medicine the provider chooses.

What it is NOT: “Sclerosant injection by either needle or catheter followed by a compression technique is not mechanochemical vein ablation,” the CPT® guidelines state. Use 37799 (Unlisted procedure, vascular surgery) for catheter injection of a sclerosant without the accompanying mechanical disruption of the vein intima, which is the inner layer.

3. Be Sure You Get the POS Right

The fees vary considerably for these surgery codes depending on whether you’re reporting physician work in a facility or nonfacility setting. As the CPT® guidelines explain, supplies and equipment required are included in payment when performed in the office setting.

For 36473, the Medicare Physician Fee Schedule (MPFS)  in Q2 of 2017 shows these national rates (meaning they’re unadjusted for geography):

  • Facility rate $179.80
  • Nonfacility rate $1,522.40.

That’s a whopping $1,342.60 difference that you don’t want to lose or have to repay because of a simple place of service (POS) mistake.

The fee difference for +36474 isn’t quite as exciting, but getting POS wrong would add up fast:

  • Facility rate $90.08
  • Nonfacility rate $278.86.

4. Think Twice Before Reporting E/M

Code 36473 has a global period of 000. Here’s the official definition for that indicator from Medicare, which makes it clear that an E/M on the same date usually isn’t payable: Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

As an add-on code, +36474 has a global period of ZZZ, which means: The code is related to another service and is always included in the global period of the other service.

How About You?

Code 36473 has an MUE of 1 in Q2 2017. Has that caused issues for you?

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Update Vaccine Codes Just in January? 4 Changes Prove That’s a Mistake

Tue, Apr 25, 2017

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July 2017 vaccination coding updates

On Friday, SuperCoder blog covered molecular pathology CPT® code updates effective July 1. Today, let’s look at what’s coming our way in July for vaccines. Because why should January 1 have all the update fun?

Schedule: The codes we’re discussing here were published on the AMA website on Jan. 1, 2017. They’re effective July 1, 2017, and will be in the printed CPT® 2018 manual.

Adopt 90587 for Dengue

July 1 brings one new code: 90587 (Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use).

Dengue is a mosquito-borne illness typically associated with tropical and subtropical areas. Patients suffer from high fever, rash, and muscle and joint pain that has earned the disease the descriptive nickname “breakbone fever.” Treatment is often limited to hydration and pain medication.

Tip: You’ll find a lightning bolt symbol next to new code 90587. The CPT® Editorial Panel allows publication of new vaccine product codes before FDA approval. A lightning bolt symbol by the code lets you know FDA approval is pending.

Make Changes to 2 Meningococcal Vax Codes

There will be a minor change to use the term MenB-4C in a revised descriptor for 90620. The revised descriptor looks like this: Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use.

MenB-4C is the complete scientific abbreviation assigned by the Advisory Committee on Immunization Practices (ACIP). The CPT® Editorial Panel approved using these abbreviations in vaccine code descriptors in the May 2014 meeting.

You’ll see a similar ACIP abbreviation update in a revised descriptor for 90621: Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or 3 dose schedule, for intramuscular use. Also note the reference to the “2 or 3 dose schedule,” which differs from the reference to only a three-dose schedule in the 90621 descriptor published in the 2017 printed manual.

Meningococcal diseases can affect the brain and spinal cord, and cause bloodstream infections. Antibiotics can treat infected patients.

Update Dose Schedule for HPV Code 90651

On July 1, a new dose schedule enters the descriptor for 90651. Here is the revised descriptor: Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use.

Instead of referencing only a three-dose schedule, the descriptor effective July 1 includes the newly approved two-dose schedule.

HPV vaccines protect against certain types of HPV, helping with prevention of genital warts and some cancers, like cervical and anal cancers.

How About You?

Were you aware that to streamline reporting of immunizations, Category I vaccine codes have July 1 and January 1 early release dates? In urgent situations, a code may even be published outside of that schedule.

 

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Review What’s New for Tier 2 MoPath Codes in July 2017

Fri, Apr 21, 2017

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july 2017

All of you who have never read the descriptor for a tier 2 molecular pathology procedure code, go check out 81400-81408. Then tip your hat to MoPath coders because those code descriptors are lo-o-o-o-ng.

To add to the fun, CPT® releases descriptor changes for these codes more than once a year. The descriptor changes effective July 1, 2017, take four pages to list, so in this post we’ll look only at additions. You can find the complete list under Downloads on AMA’s CPT® Molecular Pathology Tier 2 Codes site.

These changes were posted to the AMA site Jan. 1, 2017; are effective July 1, 2017; and will be published in the CPT® 2018 manual.

Look for New Tests Listed Under 81405

Before starting its long list of tests, the descriptor for 81405 begins with “Molecular pathology procedure, Level 6 (e.g., analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis).”

(Would be nice if 81405 was for level 5 and not level 6, right? But you can’t have everything.)

Effective July 1, insert these additions to the descriptor for 81405:

  • CPOX (coproporphyrinogen oxidase) (e.g., hereditary coproporphyria), full gene sequence
  • CTRC (chymotrypsin C) (e.g., hereditary pancreatitis), full gene sequence
  • PKLR (pyruvate kinase, liver and RBC) (e.g., pyruvate kinase deficiency), full gene sequence.

Code 81406 Adds 2, Too

The descriptor for level 7 code 81406 begins this way: “Molecular pathology procedure, Level 7 (e.g., analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons, cytogenomic array analysis for neoplasia).”

  • HMBS (hydroxymethylbilane synthase) (e.g., acute intermittent porphyria), full gene sequence
  • PPOX (protoporphyrinogen oxidase) (e.g., variegate porphyria), full gene sequence.

How About You?

Do you report MoPath tests? What tips would you offer someone just starting out in the specialty?

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2 Costly Hip Coding Mistakes Corrected

Tue, Apr 18, 2017

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hip coding tips

With all the hippity hoppity talk this time of year, I have coding for hips on the brain. Might as well go with it and look into some hip coding tips!

1. Watch for Mod 22 Opportunities With Congenital Cases

If your surgeon performs hip replacement surgery for a developmental or congenital hip dislocation, there’s a decent chance the procedure required enough extra time and work to merit the use of modifier 22 (Increased procedural services).

Don’t assume: The diagnosis alone doesn’t support use of this pay-enhancing modifier. Details of the work and time required beyond the normal range is key to convincing the payer.

In clinical documentation improvement training, inform surgeons about the reimbursement benefits of including a separate paragraph in the op note describing any extra work required for an individual case. Documentation that gives the reviewer clear information will go a long way. For instance, if an underdeveloped acetabulum requires advanced techniques and complex implants during the surgery, the op note should spell that out, identifying how the current case differs from a typical one.

2. Know Your Payer’s Edits and Expectations

You may find that different payers have different rules about which codes may be reported together. Keeping tabs on individual payer edits can be worth the effort if you discover you’ve been ignoring a reportable code.

Example 1: Suppose a patient previously underwent open reduction with internal fixation for a femoral neck fracture. Now, due to nonunion, the patient requires hip hemiarthroplasty with adductor tenotomy and hardware removal. The relevant codes are:

  • 27125 (Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty))
  • 27001 (Tenotomy, adductor of hip, open)
  • 20680 (Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)).

Medicare Correct Coding Initiative (CCI) edits prevent payment for 20680 when reported with 27125. But other payers may not apply that edit. You don’t want to miss legitimate opportunities to receive payment for both codes.

Example 2: For a patient who had a subtrochanteric osteotomy in the past and has another as part of total hip arthroplasty, you should report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft). Should you also report osteotomy code 27165 (Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast)? CCI doesn’t bundle the two codes, but some payers may not pay for both on the same claim. Knowing payer rules will help your practice know what to expect as reimbursement.

Bonus tip: When you do report more than one code, know your payer’s rule for modifier 51 (Multiple procedures). Medicare asks you not to use modifier 51, but other payers may require you to use the modifier on codes for additional procedures when you report more than one procedure for a patient on the same date.

How About You?

Have any hip coding success stories to share?

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Welcome Spring With 3 Laceration Coding Scenarios

Mon, Apr 10, 2017

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power up your laceration coding

The weather is getting warm enough for bare feet, knees, and elbows, and that leaves them more vulnerable to lacerations. Check out these three scenarios to help you choose correct codes for those cuts, powering up your laceration coding skills for spring.

Case 1: Don’t Overcode for Bandaging Skinned Knee

Suppose an established patient presents to the pediatrician with a skinned right knee. The provider examines the knee, cleans it with warm soapy water, and applies gauze and sterilized bandages.

Should you report a simple repair, an E/M code, or both?

In this case, you should use an E/M code to cover the complete service. Generally, if the provider uses adhesive strips or bandaging, then the E/M code will be sufficient to cover what the provider did.

Case 2: Know Payer Preference for Tissue Adhesive Repair

Now imagine a Medicare patient presenting to a family practice for a 2 cm scalp laceration. The provider uses a tissue adhesive for the repair.

Should you report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less)?

That code is a good choice except for one thing. Medicare accepts G0168 (Wound closure utilizing tissue adhesive(s) only). For other payers, 12001 may be appropriate.

Tip: In your manual or in your coding software, add a note with the CPT® laceration repair codes to remind yourself about G0168.

Case 3: Factor in Foreign Body Removal

In our final example, consider the coding for a patient who presents to the emergency department after stepping on a pile of branches and getting a puncture wound. The ED physician administers anesthesia, uses a blade to make an incision, explores the wound, and finds a foreign body extending into the deep tissues, including the fascia. The physician removes the foreign body and closes the wound.

Should you report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple)?

While 10120 does describe foreign body removal requiring incision. There’s a better option for this case: 28192 (Removal of foreign body, foot; deep).

If you caught the correct code, your wallet will be happy. Code 10120 pays about $105 in the facility setting, while the Medicare Physician Fee Schedule shows a national rate of $323 for 28192.

How About You?

What’s your best tip for how to ensure correct laceration repair coding? We didn’t go into ICD-10 codes here, but do you find diagnosis coding requirements for lacerations tough to take?

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60 Days & 6 Years: The Numbers to Know to Comply With Medicare’s Overpayment Rule

Tue, Apr 4, 2017

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Check that calendar!

You get a fairly clear picture of what this rule is about from its name: Medicare Reporting and Returning of Self-Identified Overpayments. If you discover Medicare gave you too much money, you have to give it back.

But there are some layers here, so let’s dig in for a refresher on some of the more important details. (It’s worth it when you consider the potential consequences of not complying include False Claims Act liability, monetary penalties, and exclusion from federal health care programs.)

60 Days Is All You Have to Give Medicare Money Back

Under the rule, providers and suppliers who get Medicare funds have to report and return overpayments by the later of these two:

  • 60 days after the date you identified the overpayment
  • The date a corresponding cost report is due (if applicable).

6 Years Is How Long Your Responsibilities Extend

The clock stops on this rule after six years, which isn’t so bad when you recall that the original plan was for a 10-year lookback period.

Experts warn that the lookback period extends back six years even if that time is before the rule became effective March 14, 2016.

Not Doing Audits Is a Bad Idea — Here’s Why

During the comment process, some worried this rule would create a chilling effect on audits if people sought to avoid finding overpayments. The final rule got around that by stretching the definition of “identification” to include the time when you actually discovered the issue or when you should have discovered it:

“A person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment.”

In other words, plan regular audits and take action to ensure compliance because Medicare is going to hold you to that standard.

What Should You Watch for to Find Overpayments?

The final rule provides some examples to help give an idea of what it means to “identify” an overpayment under this rule. For instance, if you discover any of these, you need to get moving to ensure your claims and compensation comply with the rule:

  • Incorrect coding that yielded increased reimbursement
  • A patient death prior to the date of service on your claim
  • Services performed by an unlicensed or excluded provider
  • Internal audit results that indicate overpayment.

And remember that you’re responsible for overpayments you should have discovered, too, as in these examples:

  • A government agency performs an audit and alerts you to a potential overpayment that you need to investigate
  • You see a significant increase in Medicare revenue with no obvious cause.

How About You?

Have you had to look into the finer details of this rule? What tips would you give others?

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Refresh Your Consult Coding Skills and See Why These Codes Earned a Star

Thu, Mar 30, 2017

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coding for consultation

Consultations didn’t go the way of the dodo when Medicare decided to stop reimbursing the codes specific to those services. Some private payers still reimburse office and outpatient consult codes 99241-99245 and inpatient consult codes 99251-99255, as long as you follow the rules.

Recharge your consult coding batteries with these documentation reminders along with a special update for 2017.

Check Off Every R for the Medical Record

When talking about coding consultations, you’ll generally see reference to three Rs: request, render, and report. Many times you’ll also see a fourth R, reason, worked in with the request requirement. Let’s flesh that out a bit more.

Request: CPT® guidelines state that there must be documentation of a request by a physician or other appropriate source for the consultation in the patient’s medical record.

Reason: Including the reason for the request helps support the medical necessity for the encounter.

Render: You’ve got to supply the consult before you ask the payer to reimburse you for it, of course.

Report: The consulting provider must have her own record of the visit but also must share her opinion and information in a written report to the requestor on any services ordered or performed.

What Rs Do You Want to Avoid?

Responsibility for managing the patient’s condition is one R you have to watch out for. If the consultant takes on responsibility for managing the patient’s condition (all or part) before completing the consultation, then you shouldn’t use a consult code. Use another appropriate E/M code instead.

Another R to beware of is referral. Documenting the term referral or referring physician may lead to the interpretation that transfer of care, not a consult, was the intended plan all along.

Shine a Light on What’s New This Year

In a nod to these changing times, 99241-99245 and 99251-99255 sport stars in the 2017 CPT® manual, identifying them as codes that may apply to synchronous, real-time telemedicine services.

When reporting these services as telemedicine consults, be sure to follow your payer’s rules on which place of service to use (such as 02 for telehealth) and which modifier to append (such as GT, Via interactive audio and video telecommunication systems, or 95, Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system).

What About You?

Do you still use consult codes? Have you coded for any telemedicine E/M services?

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Here’s What’s New in Q2 for CCI, MPFS, and HCPCS

Mon, Mar 27, 2017

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time-to-update

It’s almost April! In addition to a potential end to the yellow pine pollen covering every surface outside my home (yours, too?), April means second quarter updates to Correct Coding Initiative (CCI) edits, fee schedules, and HCPCS. Ready for some highlights? Let’s go!

CCI for Moderate Sedation Goes Retro

If you read this blog regularly, you know that the big CCI news for moderate sedation is the retroactive deletion of several erroneously added edits. The list of deletions is almost identical to the original announcement, but there is one difference.

The CCI contractor originally stated it was an error to have edits bundling moderate sedation codes 99151-+99153 into 45990 (Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic). But the April 2017 version of CCI keeps in place the moderate sedation edits for 45990, which you may have noticed refers to general, spinal, or epidural anesthesia.

Remember: Retroactive deletion back to the date of the creation of the edits means it’s as if the edits never existed. If you received denials for moderate sedation based on those specific edits, you may appeal the denial (or follow your payer’s preferred process) to get those denied codes paid after the April 1 update is implemented.

38,000 to go: There are more than 38,000 changes in the quarterly update for physician/practitioner CCI edits (and for the outpatient CCI version, too), including many affecting lab and nerve block codes, so be sure your CCI resource is up to date and that you check for edits before you submit your claims.

MPFS Goes Back in Time, Too

Retroactive changes aren’t limited just to CCI. The Medicare Physician Fee Schedule (MPFS) will have some changes implemented April 3 but effective back on Jan. 1, 2017. MLN Matters MM9977 offers a list of changes. Here’s a quick look:

  • Presumptive drug test codes G0477-G0479 change to procedure status I, meaning the codes aren’t valid for Medicare (adding to a grab-bag of changes related to these codes for 2017)
  • Spine stabilization codes 22867 and 22869 change the assistant surgery indicator from 1 (no payment) to 2 (payment allowed)
  • Ophthalmic biometry codes (professional component) 76519-26 and 92136-26 get bilateral surgery indicator 3
  • Physical therapy eval codes 97161-97163 see a PE RVU increase from 0.98 to 1.00
  • Occupational therapy eval codes 97165-97167 see a PE RVU increase from 0.91 to 1.32
  • Occupational therapy re-evaluation code 97168 sees a PE RVU increase from 0.65 to 0.93.

Tip: MPFS isn’t the only Medicare fee schedule that gets an April update. Confirm that you have current information for areas like DMEPOS, ASC, and drugs, too, if they affect you.

HCPCS Gains Some C Codes

Finally, for you outpatient coders, there are some new OPPS pass-through drug HCPCS codes effective April 1:

  • C9484 (Injection, eteplirsen, 10 mg)
  • C9485 (Injection, olaratumab, 10 mg)
  • C9486 (Injection, granisetron extended release, 0.1 mg)
  • C9487 (Ustekinumab, for intravenous injection, 1 mg)
  • C9488 (Injection, conivaptan hydrochloride, 1 mg).

How About You?

Which quarterly updates affect you? Did you hold your moderate sedation claims until the CCI change?

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How Do AHCA Amendments Affect Medicaid?

Thu, Mar 23, 2017

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US capitol building

The US House of Representatives is scheduled to vote on the American Health Care Act (AHCA) today, Thursday, March 23, 2017. To put it mildly, there are more than a few opinions out there about AHCA. The GOP bill repeals and replaces the Affordable Care Act, often called the ACA or Obamacare. If the bill passes in the House, it will move on to the Senate for consideration. [UPDATE: The AHCA was pulled before a vote was taken in the House.]

Repealing the ACA was one of the issues President Trump campaigned on. Another bullet point in his campaign’s healthcare position statement was a switch to block grants (lump sums) to states to reduce federal involvement in and oversight of Medicaid. Block grants came up in the amendments to the AHCA from House Republicans on Monday. Here’s a quick overview of some of these last minute amendments related to Medicaid.

End Expansion

The original bill included phasing out Medicaid expansion for certain childless, able-bodied adults, and an amendment accelerates the process. The ACA included an enhanced Federal Medical Assistance Percentage (FMAP) for Medicaid expansion. In short, the FMAP is the percentage rate of expenses that the federal government pays states. Among other changes, there is an AHCA amendment that limits the enhanced FMAP to states that expanded Medicaid coverage to the specified able-bodied adults as of March 1, 2017 (a date that has already passed).

Allow Work Requirements

Also in the amendments is a 5 percent increase in federal assistance for a state that institutes a work requirement for able-bodied adult Medicaid recipients. Able-bodied essentially means not disabled, not elderly, and not pregnant. The amendment allows for a variety of definitions of “work” and for exceptions to the requirement.

Family work status statistics available for 2015 indicate that 63 percent of nonelderly Medicaid recipients have at least one full time worker and another 14 percent have a part time worker, for a total of 77 percent.

Offer Block Grants

At the present time, Medicaid funding involves the federal government paying states for a certain percentage of program expenses, as mentioned above in the FMAP discussion. The percentage varies by states.

The current bill includes a per capita cap system, which means the state gets a set amount per person enrolled.

An amendment offers a block grant option (not applicable to elderly and disabled participants), which would give the state a fixed amount not tied to the number of participants. That approach means the amount to the state wouldn’t adjust for increases in enrollment. The block grant approach gives states a lot of leeway in deciding who gets covered and what services are available to them.

Members of individual provider types, like facility or home care, raise the question of who will win and who will lose state by state as different groups vie for resources.

How About You?

How do you see a change from the ACA affecting your job?

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Work Your Way Through This Vertebroplasty Coding Example

Thu, Mar 16, 2017

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coding for vertebroplasty

When you think of all the bits and pieces a spine includes, it’s no surprise coding for spine services can get complicated. Today we’ll tackle this tough subject by walking through an example from Orthopedic Coding Alert.

Here’s the example: The operative note shows bilateral vertebroplasty at vertebrae T10, T11, T12, L1, and L2.

Which CPT® codes should you report?

Narrow Your Options to Vertebroplasty Codes

CPT® includes vertebroplasty and vertebral augmentation (like kyphoplasty) in the sequence 22510-+22515.

Codes 22510-+22512 are specific to percutaneous vertebroplasty:

  • 22510-+22512, Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance

Codes 22513-+22515 apply to percutaneous vertebral augmentation:

  • 22513-+22515, Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance

Our example says the case involves vertebroplasty, limiting us to 22510-+22512, but determining which spine stabilizing procedure is involved in a real case may be more difficult. Keep these pointers in mind:

  • Vertebroplasty: The provider injects bone cement into the fractured vertebra.
  • Vertebral augmentation: The provider injects bone cement into the fractured vertebra after augmenting the vertebral height, which typically involves using a balloon catheter to create a cavity for the bone cement, often polymethylmethacrylate (PMMA). Terms like balloon, inflatable bone tamp, balloon-assisted percutaneous vertebroplasty, and kyphoplasty may point you to 22513-+22515.

Add Your Code Options

Now that you’ve narrowed your code options to 22510-+22512 for vertebroplasty, the time has arrived to choose the codes — and units — specific to the case.

Report one unit of 22510 (… cervicothoracic) for the primary thoracic level T10.

For the two additional thoracic levels (T11 and T12) and the two lumbar levels (L1 and L2), you should report a total of four units of add-on code +22512 (… each additional cervicothoracic or lumbosacral vertebral body [List separately in addition to code for primary procedure]).

Be sure to catch that you reported a single primary code even though the service involved both the thoracic and lumbar spinal regions.

Note that this coding also follows two important rules established by the code descriptors:

  • Each code unit represents one vertebral body
  • Each code is appropriate regardless of whether the service is unilateral or bilateral, so you should not append modifier 50 (Bilateral procedure) or report double the units for a bilateral service.

How About You?

What terms help you determine which of these codes to report?

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